不同营养护理方案对重症脑出血开颅术后患者营养和神经康复影响的对比研究

Comparative study on the effects of two different nutrition nursing programs on nutrition and neuropathy in patients with severe cerebral hemorrhage craniotomy

目的探讨完全肠外营养和早期低热量肠内营养对重症脑出血开颅术后患者营养状况和神经功能康复的影响。方法选取该院2016年1月至2017年12月收治的重症脑出血开颅术后患者80例,按照随机数字表法分为观察组和对照组,各40例。对照组采用完全肠外营养进行干预,观察组采用低热量肠内营养进行干预。观察干预前2组患者的营养状况[非瘫痪侧肱三头肌皮褶厚度(TSF)、上臂三头肌肌围(MAMC)、血清清蛋白(ALB)、血清前清蛋白(PAB)、血红蛋白(Hb)]、免疫功能(CD3^+、CD4^+、CD8^+、IgA、IgG、IgM),以及干预前后神经功能康复指标[美国国立卫生研究院卒中量表(NIHSS)评分及Barthel指数(BI)评分],采用格拉斯哥昏迷量表(GCS)评分评定2组干预前后患者的昏迷程度,并对患者神经功能的康复情况与营养状况进行相关性分析。结果干预前,2组患者NIHSS评分及BI评分、GCS评分比较,差异均无统计学意义(P>0.05)。干预后,观察组患者TSF、MAMC、ALB、PAB、Hb、CD3^+、CD4^+和IgA、IgG、IgM,以及NIHSS评分、BI评分、GCS评分均明显改善,且优于对照组,差异均有统计学意义(P<0.05)。NIHSS评分与Hb、ALB、PAB水平呈明显的负相关[相关系数(r)=-0.259、-0.349、-0.437,P<0.05)];BI评分与Hb、ALB、PAB水平呈明显的负相关(r=-0.256、-0.346、-0.411,P<0.05)。结论患者的神经功能缺损程度与患者的营养状况呈明显的负相关。低热量肠内营养能够明显改善重症脑出血开颅术后患者的营养指标和免疫功能,促进神经功能康复。

Objective To study the effect of complete parenteral nutrition and early low calorie enteral nutrition nursing regimen on nutritional status and neurological rehabilitation in patients with severe cerebral hemorrhage after craniotomy.Methods A total of 80 patients with severe cerebral hemorrhage after craniotomy admitted in the hospital were divided into two groups according to the random number table method.The observation group and the control group was 40 cases each.The control group was treated with complete parenteral nutrition,while the observation group was treated with early low calorie enteral nutrition.The nutritional status[non-paralyzed side triceps brachii dermal fold thickness(TSF),upper arm triceps muscle circumference(MAMC),serum albumin(ALB),serum prealbumin(PAB),hemoglobin(Hb)],immune function(CD3^+,CD4^+,CD8^+,IgA,IgG,IgM)]and neurological rehabilitation index[NIH stroke scale(NHISS)score and Barthel index(BI)score]were observed in two groups before and after intervention.Glasgow coma scale(GCS)score was used to assess the coma degree of the patients in the two groups before and after the intervention,and the correlation between the neurological rehabilitation status of the patients and the nutritional status was analyzed.Results Before the intervention,there were no significant differences in NIHSS score and BI score between the two groups(P >0.05).After intervention,the TSF,MAMC,ALB,PAB,Hb,CD3^+,CD4^+,IgA,IgG,IgM,and NIHSS score,BI score and GCS score in the observation group were significantly improved and better than those in the control group(P<0.05).The NIHSS score was negatively correlated with Hb,ALB,PAB[correlation coefficient(r)=-0.259,-0.349,-0.437,P<0.05)];BI score was negatively correlated with Hb,ALB,PAB(r=-0.256,-0.346,-0.411,P<0.05).Conclusions There is a significant negative correlation between the degree of neurological deficit and the patient′s nutritional status.Low calorie enteral nutrition can significantly improve the nutritional index and immune function of patients with severe cerebral hemorrhage after craniotomy,and promote the recovery of neurological function.